| NPI | 1497956197 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: GA PT009786) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: SC 5961) |
| 225100000X Physical Therapist (Licence: FL PT16505) | |
| Enumeration Date | 2007-05-30 |
| Last Update Date | 2019-08-14 |